To evaluate the hypothesis that the proinflammatory cytokines IL-1, IL-6, and tumor necrosis factor-alpha might be the link between prenatal intrauterine infection (IUI) and neonatal brain damage, the authors review the relevant epidemiologic and cytokine literature. Maternal IUI appears to increase the risk of preterm delivery, which in turn is associated with an increased risk of intraventricular hemorrhage, neonatal white matter damage, and subsequent cerebral palsy. IL-1, IL-6, and TNF-alpha have been found associated with IUI, preterm birth, neonatal infections. and neonatal brain damage. Unifying models not only postulate the presence of cytokines in the three relevant maternal/fetal compartments (uterus, fetal circulation, and fetal brain) and the ability of the cytokines to cross boundaries (placenta and blood-brain barrier) between these compartments, but also postulate how proinflammatory cytokines might lead to IVH and neonatal white matter damage during prenatal maternal infection. Interrupting the proinflammatory cytokine cascade might prevent later disability in those born near the end of the second trimester.

Blood-Brain Barrier↗

PubMed1997

Duration of transient hyperechoic images of white matter in very-low-birthweight infants: a proposed classification.

To enhance the comparability of research results, a uniform terminology is proposed for the description of the duration of transient hyperechoic images of white matter seen on cranial ultrasound scans of very-low-birthweight infants. The term 'flare' should be restricted to any hyperechoic image that resolves completely without any abnormality in its place. A flare should be termed 'brief' if it resolves within 6 days of its appearance, 'intermediate' if it disappears between 7 and 13 days after onset, and 'prolonged' if it disappears on day 14 or later.

Brain Diseases↗

PubMed1996

Low birthweight in Germany 1990-92.

The reunification in 1990 of the German Democratic Republic (GDR) and the Federal Republic of Germany (FRG) produced profound social transformations. Changes in the distribution of low birthweight (LBW, < 2500 g) in the two parts of the country between 1990 and 1992 have been studied by analysing vital statistics for the period. In absolute numbers, livebirths in the former FRG remained stable, while those in the former GDR declined by 51%. Numbers of LBW livebirths increased slightly in the former FRG and decreased in the former GDR; those in the category between 500 and 999 g remained stable in the former GDR and increased in the former FRG. However in terms of proportion, livebirths in this category doubled in the former GDR. Migration rates for the same period showed a shifting population from East to West particularly of young people, and maternal age-specific numbers of livebirths decreased in both countries. Psychosocial stress may have contributed to the rise in ELBW, but it is also possible that the improvement and sharing of perinatal management strategies may have led to increased survival of babies < 1000 g. Most importantly, the observed rise in the proportion of ELBW births (except those < 500 g) could be a result of the introduction of the more comprehensive definition of livebirth into the former GDR.

Adult↗

PubMed1996

Development of a regional cohort of very-low-birthweight children at six years: cognitive abilities are associated with neurological disability and social background.

The authors studied the intelligence, memory, visuomotor skills and la nguage of 298 six-year-old children with very low birthweight (VLBW) (less that 1500g). Of 591 VLBW childern born July 1983 to June 1986 within 50km of the centre of Hamburg, Germany, 330 were traceable at age six years and 298 of these were seen by a neuropaediatrician and a psychologist; the other 19 were too severely disabled for psychological assessment with the standardized tests used. The mean memory performance of VLBW children at age six years was below the standard mean in all diagnostic and socio-economic subgroups. As expected, visuomotor development was clearly influenced by neurological but not socio-economic status. Intelligence and language skills were much more closely related to socio-economic background that to neurological morbidity. However, VLBW children with hyperactivity, clumsiness or cerebral palsy differed significantly in intelligence and visuomotor performance from those without neurological symptoms.

Cerebral Palsy↗

PubMed1996

Decreasing melatonin and 6-hydroxymelatonin sulfate excretion with advancing gestational age in preterm and term newborn male infants.

We investigated the ontogeny of melatonin synthesis during fetal maturation by measuring the melatonin (MLT) and 6-hydroxymelatonin sulfate (MLTS) excretion in the urine of male infants aged 2-7 days and gestational age 26-42 weeks. We found a negative correlation between advancing gestational age and the MLT and MLTS excretion expressed as total 24-h amount, ratio of 24-h amount to creatinine and ratio of 24-h amount to body surface area. The ratio of MLT to MLTS was found to be about ten times higher in the study group than in prepubertal children, which might reflect the immaturity of hepatic sulfation capacities. The total amount of excreted MLT and MLTS was only one-tenth the prepubertal values. No day/night differences in MLT and MLTS excretion could be detected. We conclude that the fetal pineal gland is capable of a limited melatonin synthesis from the 26th week of gestation onwards, with decreasing values reaching its nadir around term. This indicates that the amount of fetal MLT excretion is not determined by synthesizing capacities of the pineal gland but by the development of neural connections to the pineal gland.

Fetus↗

PubMed1995

Malignant melanotic neuroectodermal tumor of infancy.

A 2-month-old boy underwent surgery for removal of a right temporal melanotic neuroectodermal tumor of infancy (MNTI). Histologically the tumor tissue showed signs of malignancy. The child was reexamined several times up to the age of 5 years. Neuroradiological evaluation showed no evidence of tumor recurrence or metastases. No resulting handicap was observed during neurological and psychological follow-up examination at the age of 5 years. Our findings confirm that surgical removal as the therapy of choice provides an excellent prognosis for this kind of tumor in spite of its histologically malignant appearance.

Brain↗

PubMed1994

Analysis of 20 primarily surgically treated chiasmatic/hypothalamic pilocytic astrocytomas.

The authors review the therapeutic results of 20 patients (aged 12 months to 30 years, mean age 9 years) with benign pilocytic astrocytoma of the chiasmatic/hypothalamic region, seen at the University Hospital Hamburg-Eppendorf between February 1980 and April 1993. Six patients suffered from neurofibromatosis 1 (NF-1). The patients were divided into two subgroups relative to tumour extension and growth patterns, as revealed by CT scans and/or MR imaging. Fourteen patients revealed a large globular suprasellar tumour extending into the hypothalamus and/or the anterior third ventricle (group A). A suprasellar tumour with optic tract involvement could be identified in six cases (group B). Subtotal (70-90%) resection was achieved in ten tumours (50%), the majority of which were of the large globular type. There were no deaths. Postoperative morbidity was comprised of visual and endocrine impairment in four patients and right hemiparesis and dysphasia in one patient. Radiation therapy was given in nine cases (45%). Three tumours (38%) were reduced in size by irradiation. Tumour progression was seen in seven patients (35%). The presence of young age and NF-1 were predictors of progressive disease in our series. Growth capacity was not related to the extent of cytoreductive surgery.

Adolescent↗

PubMed1994

Hypothalamic hamartomas: with special reference to gelastic epilepsy and surgery.

This study presents six patients with hypothalamic hamartomas diagnosed on the basis of magnetic resonance imaging. Histological confirmation was performed in three patients who underwent surgery. Immunohistological assays were used to determine the neurosecretory pattern. Four patients presented with epilepsy, including gelastic seizures. Other symptoms included behavioral abnormalities in four patients and precocious puberty and visual impairment in two patients. One patient presented associated developmental defects. Good results without morbidity were achieved with surgical resectioning in two patients with large hamartomas associated with behavioral abnormalities and gelastic epilepsy that was unresponsive to conventional medical treatment and in one patient with visual impairment. We propose a classification of the hypothalamic hamartomas based on topographical and clinical data obtained from 36 selected cases in the literature and six of our own cases. This classification should help to classify the various treatment methods and the surgical risks into four subgroups (Types la, lb, lla, and llb). We conclude that the surgical approach is a realistic alternative in certain cases, including large and broad-based Type llb hamartomas associated with gelastic epilepsy and behavioral disorders.

Adult↗

PubMed1993

Etiological classification of cerebral palsy in very low birthweight infants.

As part of a longitudinal follow-up program a single case analysis of the history of 53 children with a birthweight of less than 1501 g, who had developed cerebral palsy, was performed. In 17 children (32%) a definite explanation for the neurological impairment and in another 17 (32%) at least a possible explanation could be found. In 19 of the 53 children (36%) the history was uneventful and did not offer a causal event. The common documentation in obstetric and pediatric case files left the cause of cerebral palsy undetected in one third of the cases.

Cerebral Palsy↗

PubMed1992

Intracranial chordoma in a neonate.

We report the first case of a congenital intracranial chordoma. Hydrocephalus, sixth and seventh cranial nerve palsy, and torticollis were observed shortly after birth. The tumour was delineated by sonography, CT scans and MRI and the diagnosis confirmed after subtotal resection at the end of the newborn period.

Abducens Nerve↗

PubMed1992

Fletcher's paradox.

Explore the source record for details and available documents.

False Negative Reactions↗

PubMedDate not supplied

[Gelastic epilepsy and precocious puberty in hamartoma of the hypothalamus].

Four cases of hypothalamic hamartoma leading to gelastic epilepsy, precocious puberty and behavioural disorders are reported. Cerebral neuroradiologic examinations revealed a tumor-like mass attached to the hypothalamus in the region of the mamillary bodies in all cases. Precocious puberty developed in the two girls at 4 and 13 months but in neither of the two boys, who both suffered behaviour disturbances in the form of aggressive outbursts. A total resection of the tumors of both boys led to histologic confirmation of hamartoma. One boy was free of seizures upon follow-up, whereas seizure frequency in the other boy was reduced, while his aggressivity increased. The cases are discussed in context of current therapeutic conceptions of gelastic epilepsy and central precocious puberty.

Aggression↗